HomeMy WebLinkAboutMortgage_Kelley (8). STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
. FOR DEDUCTION FROM ASSESSED VALUATION
Slate Farm 43709 (R70 /11-08)
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INSTRUCTIONS: Fle Mark
tii;,��ias °j �IG6�rtyM��aa�w �%(��urea��u 9,,�1oceted JUN 0 5 Z009
2J Mo6de / Manulactured Homes nW essessed as Real PropeAy: Must fde dunrg tlie fweNe (12) mmfhs befae March 310l each year
the deCucfion is sought. � ��
See �ev�se side lor eddAional insWdions eM 4uefificetions �
Applicanl (m�nrrar mMracf Gh'�- see Rsbidions m mrxrse side) GIB
atU 1. ameN yea
/083 (000
ro. what is h�s / �m exatl share d i�res11
Y name on fewrd o
Narne d mortgagae
-.rFr�
��� � ���
,y O $O K,
' U�D'Y U
tpage / Cmltacl "v
d� 1. umeN year
iat¢ bBbv:.
or canrza se0er (nunbe�and s7mo4 �: slate. and
uGSLEY IJr_ Ci.VciNN
m aner
Does aPp6ranl awn pmperty in aM otirer
munty m InGvre1
n Yes n No
u�d as of I Alongape / Canracl
date of appfim6p�
r
spnsse,
06
as d
IIegal ar ep�table avneR
Z, j �C7 ves u No
ale wiTh wtm�
$ the pmparty in puestim: AnnuaRy Assessed
�RealProverty ❑Annua�ynssessed
Has IhLs dedutlion been reCuestgd w 7�PeM
(or airtarrt yeaR ❑ No
❑ Yes
COUNTY AUDITOR
DeduGion approved rti Iha amoum d:
20 20 20 _ 20 20 _ 20 _ 20
SipnaNra dCountyAUdi�a camry Da�a �mmu, day, yca�
I/ We certi(y under the penalty of pujury that the above aM foregoing mfomiation is true and cwred and that Ue applicant is a resident of InOiana antl
owner / mnhact buyer af the aforementionetl property on tlate aPDlication a filed.
Shanzlu;e (c:.+z/s hs rum.c: 7ata :.^r_x�tS. 'ay y�.w
oC� �o � %
F�A easident addmss d applkant (nvnba arW . tlry, sfa�, and LP oodo)
�. G e�v�aLe S. �i.cJceTo�v Zi� 5�7�70
Persrn aWhwrzeE by duly ezecuted Power d Atbmey or by IC 6-1.1-72-0.7 Dala (monM, tlay, yoar)
PtlGress of aNAaiieO parson (nvnbri antl shee( ti(y, ffife, antl LP mEO)